More than 100 Lancashire and South Cumbria GP practices could shut within two years, doctors warn

That is according to an anonymised survey which assessed the financial health of the region’s practices - and found that seven are in such a perilous position that they consider themselves under “immediate” threat of having to shut their doors.

A further 94 said that they could end up on the same life support over the next 18-24 months if their situation does not improve. GPs blame reduced income, rising costs and difficulty in recruiting essential staff for the fact that so many of them fear for the future of their practices.

The survey was carried out for a new report published by the Consortium of Lancashire and Cumbria Local Medical Committees (LMCs), which estimates that the average surgery has taken a £350,000 hit to its budget because of the recent spike in inflation.

The organisation's chief executive officer, Fleetwood GP Dr. Adam Janjua, told the Local Democracy Reporting Service (LDRS) that the findings crystalised his long-held concern that general practice is silently heading for a tipping point which will push many surgeries past the point of no return.

“I think there's a very real threat of practice closures in the very near future. I hope it doesn't transpire, because…that will severely hamper access for patients [who] think that the access [to GPs] is already quite poor.

“[But] if there isn't an immediate effort to try and help the situation - with funding, in particular, but also…other [issues] - I think we're going to see lots of practices close.

“I think it's going to be a watershed moment - and, by that time, it'll be too late. Patients won't be able to protest and stop those kinds of closures, because it will just have gone under the radar until...the crisis point hits everyone,” Dr. Janjua warned.

He added that a report this week by GP magazine Pulse, suggesting that the government’s initial offer for this year’s new GP contract amounts to a 1.9 percent uplift to baseline funding, "amounts to a massive cut and will definitely hasten any practice closures".

Based on the findings of its survey - which had an 83 percent response rate from Lancashire and South Cumbria's 193 practices - the LMC consortium calculates that 1.1m patients, out of a population of 1.8 million people, are at an “immediate [or] medium-term risk of losing their GP surgery”.

Blackpool, Blackburn with Darwen, East Lancashire and Morecambe Bay all have surgeries that class themselves at immediate risk - with Blackburn having the highest proportion, at 12.5 percent of its practices - while Greater Preston, Chorley and South Ribble, West Lancashire and Fylde and Wyre have none.

However, at least 40 percent of the surgeries in all areas believe they could be under threat within two years, with Chorley and South Ribble registering more than double that proportion, at 83 percent.

The consortium’s report - “The Financial Challenge Facing Practices in Lancashire and Cumbria” - suggests that the pressure posed by rising costs, including wage growth, has been exacerbated by GPs acting as the safety net for the strain the broader health and social care system is under.

The dossier highlights a funding gap that it says has opened up in general practice - amounting to a shortfall of more than £35 per patient - as a result of how inflation has soared during the current five-year GP contract for delivering services.

Under the terms of that deal - which began in April 2019 - GPs have received funding increases of just over two percent each year, totalling 11 percent across the period as a whole. However, in order to have kept pace with inflation over that time, surgeries would have needed a 28 percent rise.

Back in October, the LMCs requested that the Lancashire and South Cumbria Integrated Care Board (ICB) bridge the gap. However, their appeal was refused, because of a lack of funding.

The ICB - the overarching body for the NHS in the region - is forecasting a deficit across the whole of the healthcare system in Lancashire and South Cumbria of £198m by the end of the current financial year in April.

Dr. Janjua accepts that national funding decisions determine the capacity of regional NHS commissioners to answer local pleas for extra cash. However, he points to what he says is a particular disparity in this region between funding for acute services, such as hospitals, and that reserved for doctors' surgeries.

The Lancashire and South Cumbria ICB is the second-highest spender of its counterparts across England on acute care, which swallows up 52 percent of its total budget. But it is 38th out of 42 ICBs nationwide for spending on general practice - after the figures have been weighted for population - to which it allocates 7.9 percent of its budget, putting it below the England average.

Nationally, the percentage of NHS spending on primary care stands at 8.4 percent. The consortium says that the figures are “staggering” when set against the fact that 90 percent of all patient contacts with the health service take place within that sector.

Dr. Janjua stresses that even an inflation-covering 28 percent increase in funding over the last five years would merely have enabled general practice to have “stood still”, when it is now facing increased demands, including from the impact of Long Covid.

“We need to be realistic about the fact that general practice is being asked to do so much more than it did five years ago,” he said.

The medic - who was himself a member of the ICB until he took up his post at the consortium of LMCs last summer - denied that the report overstated the threat facing GP surgeries and appealed to the public to read it and reach their own conclusions. He also called on politicians of all colours to show the "leadership" needed to help the NHS navigate the current crisis.

Dr. Janjua says that the “resilience [of] the workforce” gives him hope for the future of his profession - but even that positive prognosis comes with a caveat.

“We can't expect that resilience to have no bounds...so we mustn't take advantage of this workforce, [because] they will burn out, they will lose the thing that makes them the pride of the NHS and the pride of the country.

“Once that happens, the spark [has] gone - and you can't bring it back.”

‘A&E PATIENTS SAY THEY CAN’T SEE A GP - TO MAKE IT LOOK LIKE THEY HAD NO OTHER OPTION’

The pressure hospitals are currently under is being filtered back down to GPs as part of a “perfect storm” of challenges for primary care, Dr. Janjua claims.

In an inversion of the more common narrative that it is difficulty getting GP appointments that causes patients to make otherwise avoidable trips to A&E, the LMC consortium’s report suggests that the “unmet needs” of the 7.6 million people now on the hospital waiting list is driving people to their family doctor’s door instead.

“They expect the general practitioners to deal with them - and rightfully so, somebody needs to be looking after these patients,” Dr. Janjua said.

“So you can see how [GP] access is now suffering, because you have [these] people…who, [previously], would have been seen very quickly by the hospital…and their problems would have been in the past. Then you [also] have people with newer problems.”

Pressed on whether an A&E medic would recognise his characterisation of the situation, Dr. Janjua said it was a common misconception that people were taking themselves to emergency departments because they could not see their GP.

“There was a study done some time ago where they asked patients in A&E why they [had gone there] - and a lot of patients said, ‘We couldn't get a GP appointment’.

“But when they…checked whether that person had actually ever had any contact with general practice for [their medical problem], they found that that wasn't necessarily the case. So when you put people on the spot, they will say different things to try and make it seem like there was no other option [but to go to A&E].

“Statistically, there hasn't been a huge increase in A&E attendances...nationally. The problem with A&E itself is because the hospitals are so full [and] they're not able to discharge people [to social care].

“If you look at the bed numbers now, compared to 10 years ago, you'd be surprised to see that there was almost double the number of beds before. So we can't have a situation where you reduce beds and then expect hospitals to be able to function the way they were,” Dr. Janjua said.

Across England, A&E attendance is broadly static, with 2.2m people visiting in December last year, a near-identical figure to the last pre-pandemic winter in December 2019. However, across Lancashire and South Cumbria, visits to A&E have increased by more than 7,000 over that period, to stand at 69,426 in December 2023.

‘HOSPITAL WORK IS BEING DUMPED ON GPs’

Once a patient has reached the front of the waiting list queue and been seen in hospital, Dr. Janjua claims they are often too quickly transferred back to the care of their GP.

“If you see a consultant in clinic and they want you to start a particular medication, it's their job to counsel you on that medication, it is their job to start you on that medication and then it is their job to make sure you're stable on it.

“Only when you're stable on it will that particular prescription be transferred to general practice. [But] in 90 percent of the cases, we are being sent letters that take weeks to arrive, where patients are being asked to be started on a medication - [and] the patient gets frustrated thinking that we're delaying it, but we're not.

“Also...if a consultant sees you and they feel you need a referral to another specialty, that should be…done by the consultant. We're clearly seeing that that is not happening - we're getting letters back saying, ‘Could you please refer this person for another test or to another department?’

“We're getting all sorts of workload being…dumped on general practice,” Dr. Janjua said.

PHONE BILL SHOCK

GP practices across Central Lancashire, the Fylde coast and West Lancashire have been left significantly out of pocket by trying to improve the experience for patients wanting to book appointments, it has been claimed.

The government last year pledged to “end the 8am rush” for a GP slot by investing in more advanced telephone systems to help deal with the volume of calls at peak times.

In May, ministers pledged £240 million to practices across England to fund the switch to the latest kit. The move had been made compulsory via a change to the GP contact two months earlier.

However, according to the LMC consortium's report, surgeries in several parts of Lancashire and South Cumbria, which had already taken the decision to strengthen their systems - and so benefit their patients - now cannot access the funding available to those practices which opted to transfer to so-called 'cloud-based telephony’ only once they were ordered to.

Early adopters of the technology have lost out to the tune of £15,000-£30,000, depending on the size of their practice. For all practices, the ongoing costs associated with the new systems can add between £3,000 and £10,000 per year to their bills.

WHAT THE NHS AND GOVERNMENT SAY

Responding to the issue raised by the LMCs, Craig Harris, chief operating officer for the Lancashire and South Cumbria ICB, said:

“The NHS Lancashire and South Cumbria Integrated Care Board was aware of the extensive work taking place to understand the financial health of Lancashire and South Cumbria general practices. We acknowledge the financial challenges outlined in the report and understand the importance of ensuring that general practice is both sustainable and resilient.

“We are particularly concerned about those practices who considered themselves to be at immediate risk of closure, and while we have only just seen the report, we will continue to work closely with our LMC colleagues to carefully consider and discuss the concerns raised.

“The ICB shares the vision of a robust, resilient, and thriving general practice which is able to, and funded to, form part of an expanded integrated community model of care.

“We also recognise the significant pressure faced by general practice staff and we are grateful for their continued hard work and commitment to their patients.”

The Department for Health and Social Care did not respond to a request for comment.

WHERE ARE THE MOST SURGERIES UNDER THREAT?

The LMC consortium's survey asked GP practices to rate their current financial situation as ‘red’, ‘amber’ or ‘green’.A red rating means a surgery is at risk of “immediate” closure, while amber indicates that such a risk is possible within 18-24 months if their financial position does not get any better. Green-rated surgeries face no immediate or medium-term threat.

BLACKBURN WITH DARWEN

Red - 12.5 percent

Amber - 56.3 percent

Green - 31.3 percent

(16 out of 22 surgeries responded)

BLACKPOOL

Red - 7.7 percent

Amber - 46.2 percent

Green - 46.2 percent

(13 out of 16 surgeries responded)

CHORLEY AND SOUTH RIBBLE

Red - 0 percent

Amber - 83.3 percent

Green - 16.7 percent

(18 out of 24 surgeries responded)

EAST LANCASHIRE

Red - 7.9 percent

Amber - 52.6 percent

Green - 39.5 percent

(38 out of 45 surgeries responded)

FYLDE AND WYRE

Red - 0 percent

Amber - 60 percent

Green - 40 percent

(15 out of 18 surgeries responded)

GREATER PRESTON

Red - 0 percent

Amber - 40 percent

Green - 60 percent

(20 out of 22 surgeries responded)

MORECAMBE BAY (INCLUDING LANCASTER)

Red - 3.5 percent

Amber - 72.4 percent

Green - 24.1 percent

(29 out of 31 surgeries responded)

WEST LANCASHIRE

Red - 0 percent

Amber - 45.5 percent

Green - 55.5 percent

(11 out of 15 surgeries responded)

Source: Consortium of Lancashire and Cumbria Local Medical Committees